Healthcare Provider Details

I. General information

NPI: 1588644280
Provider Name (Legal Business Name): DIWAKAR KINRA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 GATEWAY CTR STE F
FLINT MI
48507-3992
US

IV. Provider business mailing address

750 REGISTRY LN
ATLANTA GA
30342-2865
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-0100
  • Fax: 810-235-0100
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number015485
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number017716
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: